Strategies for Achieving Whole-Practice Engagement and Buy-in to the Patient-Centered Medical Home

Bleser, et.al. do a magnificent job at describing the complexities of transforming what might have been described as a "traditional" medical practice into the new model that is called a Patient-Centered Medical Home - or PCMH. There are no surprises in their findings which are so clearly spelled out in the major components of change and in the details enumerated in each. Who could argue that we need champions for change in each locale, new and dedicated resources and a team which can function with shared goals and a shared vision for change?

What puzzles me most is that those that were interviewed seemed to miss some of the most fundamental issues related to this transformation. Barely a mention was made of how professionals, with little or no input from their patients, can claim to be building a "patient-centered" practice. It is critical to understand the components of patient centeredness and how they are incorporated into the construction of a vision for a changed system. What does it mean to be patient centered? Do patients need to be a part of developing a vision for the practice? Could they be helpful in motivating the providers and other staff of the practices towards change? What would patients ask for and who would champion that vision in the practice?

Here are one example to stimulate our thinking. Our patients want extended hours for our practices and for their providers. They want our practices open 7 days a week, 365 days a year. They want them open earlier in the morning and open every evening. They want to be able to see their own provider whenever they need to be seen. Patients also want more efficient answering of our phones, appointments when they need (or want) them, and often want more time with us than we can give them. On our governing Board of Directors at the Institute for Family Health in New York, made up 75% of patients of our practices, those discussions take place and try to create a balance between the realities of life for our staff and the desires of our patients. We are asking our providers and staff to flex their time to make our practices more patient-centered and to make their appointment schedules more flexible. It is difficult to find provider champions for such a change, resources to make it happen and to create real teams when schedules are made so complex.

If we are serious about what PCMH is all about - and we must be - we need to take the analysis one step deeper - understanding that the system we created before, and to some extent the system we are creating now, is deeply rooted in the foundation of a practice that is driven by what providers think is in the best interests of the patient and not what patients want. It is more than rhetoric that we need to figure out how to put patients themselves at the center of our care models, how that will be championed in our practices and how their continued involvement will create inputs into the development of the health care team. This paper would provide an excellent framework to delineate the many places where patient input could be introduced into the PCMH model.

Competing interests: None declared